Dialectical Behavior Therapy: How Does It Work?

Dialectical behavior therapy (DBT) is a branch of cognitive-behavioral therapy (CBT). It is commonly used to treat mental health problems like borderline personality disorder and suicidal behavior. It has also been adapted to help people with mood disorders, posttraumatic stress disorder, eating disorders and ADHD. Its main aim is to teach coping skills to help patients deal with change and dismantle unhealthy behaviors. So what techniques are used in dialectical behavior therapy, and how does it work?

What Is Dialectical Behavior Therapy?

Dialectical behavior therapy balances the patient's experience in the here and now with the need to change negative or problematic behaviors. DBT can be practiced in either individual or group therapy, or it can also be coached over the phone in emergencies – such as when someone is suicidal or engaging in risky behavior.  

Dialectical behavior therapy (DBT) was first developed in the 1980s when it was reported that patients with borderline personality disorder did not respond to CBT alone.

Dialectical behavior therapy is unique in that it brings together two opposing concepts – acceptance and change – and helps patients embrace both. The term “dialectical” originates from the concept of "dialectics," in which everything is composed of opposites and all things are interconnected. Dialectics also works on the basis that change is constant and inevitable, and opposites can be integrated into therapy to form an individualized approach that is truthful and realistic.

Dialectical Behavior Therapy (DBT): How Does It Work?

Like CBT, dialectical behavior therapy (DBT) encourages the patient to take ownership of their recovery, which fosters self-sufficiency. DBT therapists will often assign homework and ask patients to fill out daily logs to track their emotions, behaviors, urges and skills. The American Psychiatric Association endorses DBT as an effective treatment for borderline personality disorder, citing improvements such as reduced suicidal behavior, better social functioning and less anger.

The patient and therapist work together to resolve the apparent contradiction between self-acceptance and change to encourage positive behaviors.

DBT can also be adapted to treat mood disorders (such as bipolar types I and II), binge eating disorders, ADHD and posttraumatic stress disorder.

Dialectical Behavior Therapy Techniques

Dialectical behavior techniques are rooted in scientific research and therapeutic success dating back to the 1980s. Techniques and strategies used in dialectical behavior therapy include:

Validation: One of the main techniques used in dialectical behavior therapy is validation. Research shows that when combining validation with the push for change, patients are more likely to accept and adapt to change and are less likely to experience distress as a result. Here, the therapist validates the patient’s experience and actions and puts them in context, while also suggesting that they may not be the best approach to solving a specific problem.  

Mindfulness: Focusing on the present is at the heart of most CBT techniques, and dialectical behavior therapy is no different. DBT teaches the patient to be mindful of the present and live in the moment.

Distress tolerance: Distress is a normal part of life for most people, but it can be particularly hard to deal with for those with severe mental health problems. DBT teaches patients to accept themselves and their situation and teaches them skills to better tolerate difficult situations. In this context, dialectical behavior therapy techniques might include distraction, weighing pros and cons, self-soothing and living in the present moment.

Interpersonal effectiveness: This technique teaches patients how to assert themselves in relationships while still keeping their associations with others positive and healthy.

Emotional regulation: People with borderline personality disorder usually struggle with emotional regulation. DBT teaches skills and coping strategies for recognizing and coping with negative emotions and reducing emotional vulnerability.

Dialectical behavior therapy is practiced in a number of different settings. If you think you might benefit from DBT, talk to your doctor or ask a mental health specialist for a referral to a DBT-trained professional.

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